A 52-year-old man with hepatitis C cirrhosis (Child-Pugh B) is started on sofosbuvir/ledipasvir. He achieves SVR12. His MELD score was 14 at baseline. Which statement correctly describes the expected outcome post-SVR in cirrhotic patients?

• A Cirrhosis is fully reversed and HCC risk returns to baseline population level
• B HCC surveillance can be stopped after 5 years of SVR
• C MELD score improves immediately to less than 6 after SVR
• D Risk of HCC is reduced but not eliminated; surveillance should continue indefinitely ✓

Explanation

Achievement of SVR12 (viral cure) in HCV cirrhosis reduces annual HCC incidence from approximately 3–8% to approximately 1–2% per year, but the risk is not eliminated due to pre-existing hepatic carcinogen exposure and architectural derangement. AASLD and EASL guidelines recommend indefinite 6-monthly HCC surveillance with ultrasound (with or without AFP) in all cirrhotic patients even after SVR. Fibrosis regression can occur over years but cirrhosis is not rapidly reversed. MELD scores may improve over months but do not normalise immediately.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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